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{ <br /> PERMIT APPLICATlON 9� ��;p <br /> CITY OF EVERETT PERMIT SFRVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (E�p��070) <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> :� P.�i RD � !oi <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> ONMER ADDRESS CITY2IP PHONE <br /> �Ij��rZ n t� 6��s�A�rr Pwk L�[ Ev,t�;� - <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> SCO�TR.�C N�� ��fIM ���i�� ���ly"�9/�Y� r� �V�IfN �I�fj y�s�9y o'1S' <br /> s k� v� P,o yyR 2 <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OP WORK <br /> Eledric _Gas_Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. � TYPE OF FIXTURE OR ITEM <br /> � Tcilet A/C–air handling unRs <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> � Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) � _ Exhaust fan <br /> BackNow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> f Floor drain Re/rigeration <br /> Grease trap _ Woodstove <br /> Rooi drains _ a� <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CnDE I$3106 <br /> I hereby certify that I have read and examined this application and know the same to De true and corteet. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein o�not.The graMing o(a pertnit does noi presume <br /> to give authority to violate or cancel the provision of any other state or loca�law regu�ating construction or the perfortnance of <br /> construction.That I am authorized by the owner of this property to peAorm the work for which applica6on is made and I compy with lhe I <br /> State Conha rs Law CW and 296.200 WAC. ! <br /> . - � <br /> Signat e wneNContractor/Authorized Agent Date .. <br />